“What Are The Most Exciting Technologies For Heart Valve Treatment?” Asks Leslie

Posted by Adam Pick, June 1, 2011

At the recent AATS meeting in Philadelphia, I was very fortunate to meet with Dr. Craig Smith, the chairman of surgery at NewYork-Presbyterian Hospital / Columbia University Medical Center.

Considering that Dr. Smith is a principal investigator on the PARTNER clinical trial – which is evaluating transcatheter aortic valve replacements – it was very helpful to get his opinions specific to Leslie’s question about technology.

Thanks to Leslie for her question. And, a special thanks to Dr. Smith for sharing his thoughts, clinical experience and research specific to the future of aortic valve replacement using percutaneous technology.

For those members of our community who are hearing impaired, I have provided a written transcript of Dr. Smith’s video interview below.

Adam: Hi everybody its Adam and I am here with Dr. Craig Smith. We have a question for Leslie that came in and she writes to me, ‘Adam I was recently diagnosed with mild to moderate aortic regurgitation. So I’m curious to learn about the future of heart valve treatment. What do the surgeons see as the most exciting technologies that could go mainstream in the next 10 years?

Dr. Craig Smith: Well before getting to the exciting new technologies it’s fair to say that if your regurgitation is only mild to moderate it could be quite a while even more than 10 years before anything is relevant. It is something that needs to be followed but I’m sure Leslie’s cardiologist will be following her but the 10 year time frame might even be too near on the horizon. If that’s not the case then she does need treatment in the next ten years or so.

Two or three things, one the most exciting new things out there is percutaneous (transcatheter) aortic valve replacements, using a catheter instead of open heart surgery are not as far along for regurgitation as they are for constructive valves. So if she has pure kind of regurgitation based on stretch of the aorta loose floppy thin leaflets, a lot of aortic valve calcification it may be quite a while before the percutaneous technologies come along to treat that as well. From what we know she may have mixed element maybe of stenotic aortic valve that’s also leaking in which case within ten years the percutaneous replacements may be highly relevant and might allow people like Leslie to avoid open heart surgery. It will depend to a great extent how quickly that technology moves down the risk scale. I’m guessing, this is probably a young woman so very low risk, probably in the next five to ten years, the percutaneous valves will be available in her category.

What she may have is a pure regurgitation syndrome often based on problems with the leaflets, the structure and quality, there is also more and more success in the last five years or so with primary aortic valve repair of the leaflets rather than replacements. That is still however an open heart procedure. Putting it all together I’d say odds are if something has to be done in the next decade it will involve surgery. If the percutaneous devices progress rapidly then it might be something that’s relative for someone like Lesley. (Click here to learn more about aortic valve repair.)

Adam: Dr. Smith, thank you so much for stopping by. I just want to acknowledge you for all the great work you’ve done for the patients out there. I know you’ve helped a lot. All the clinical work and the research your doing to help move heart valve treatment to better places.